General Surgery

General Surgery

Dr. Sanjay Nalachandran is a qualified Vascular & General Surgeon. He performs a variety of surgery for vascular and common general surgical conditions and to compliment his practice, he has attended specialized courses in aesthetics.

Conventional surgery for varicose veins

Endoscopy services

Laparoscopic procedures for hernia, appendicitis and gallbladder

Stenting and angioplasty procedures for peripheral arterial disease

Stenting for thoracic/abdominal aortic aneurysms

Surgery for lumps/bumps

Surgery for peripheral arterial disease ie bypass/endarterectomy

Surgery for piles, haemorrhoids, anal fissures

Surgery for renal dialysis

PILES

Piles or haemorrhoids are venous swellings of the anal cushions. The anal cushion is an area situated between the rectum and the anal opening. Piles can be graded by their position or their severity. They can be internal or external.Piles can be distinguished by their severity:

Grade1: 1st degree piles are located inside the anal canal, they cannot be seen and may cause bleeding.

Grade 3: 3rd degree piles prolapsed during bowel movement and can only be “reduced” or returned into the anal canal manually.

Grade 4: 4th degree piles are permanently outside the anal canal. They are usually rather large , swollen and painful and may have clots in them.

Piles are caused by low-fibre diet, straining during bowel movements, constipation, pregnancy, age and are associated with a positive family history.

Piles can have various symptoms:

Lump at the anus

Itching

Sensation of “incomplete” bowel movement

Mucus discharge

Bleeding

Treatment

Medical:

Lifestyle

Increase fluid intake

Avoid straining

Daily bowel movement

High fibre diet

Medication

Fibre supplements eg Fybogel

Stool softeners eg Lactulose

Topical creams/suppositories

Non surgical:

Banding/ ligation-Using an endoscope, “rubber” band is applied around the piles to “strangulate” and “shrink” it

Sclerotherapy-injecting piles with a sclerosant to “shrink” it

Surgery:

Conventional-The pile is excised and vessels ligated under general anaesthesia. The wounds are left to heal naturally.

Stapler haemorrhoidectomy-Circular stapling device excises tissue above the piles. The piles are “pulled” back up the anal canal and “shrink” over time. Less pain, shorter hospital stay and shorter recovery period compared to the conventional method of surgery.

Haemorrhoidal artery ligation-Using a Doppler, vessels supplying the piles are ligated using sutures.

GALLSTONES

The gallbladder is a sac located just beneath the liver. It stores bile which is produced by the liver, the bile is secreted into the intestines to aid in fat digestion. Gallstones arise when bile “hardens”. There are 2 types of gallstones, cholesterol and pigmented stones. Cholesterol stones are more common( ~80%) and are usually yellow whereas pigmented stones are usually dark and small.

Gallstones are more common in women( pregnancy, hormone replacement or birth control pills). Other risk factors of developing gallstones are age , family history, diabetes, cholesterol lowering drugs and high fat/cholesterol diet.

Gallstones can cause a variety of symptoms:

Abdominal pain( usually right upper abdomen)

Fever/chills

Jaundice

Dark urine/pale stool

The most sensitive and effective way of diagnosing gallstones is with an ultrasound scan. If gallstones have caused symptoms, then surgery is required. Many patients have gallstones that do not cause any symptoms, there are called “silent” gallstone and do not require treatment.

Surgery for gallstones is called Cholecystectomy. Nearly all are performed laparoscopically or using key-hole surgery nowadays. Using tiny incisions, the gallstones are removed together with the gallbladder. The gallbladder is a reservoir for bile, it is an organ that can be ‘removed’ without ill health. After removal of the gallbladder, the bile now flows directly from the liver to the intestines.

Recovery is usually 1 -3 days in hospital after which normal activity is resumed after 1 week.

If there is severe inflammation, scarring or infection of the gallbladder, key-hole surgery may not feasible and “open” surgery is required. This involves making an 5-6 inch incision over the right side of the abdomen and “removing” the gallbladder safely. Recovery is longer than the key- hole method due to pain from the incision. “Open” surgery is necessary in about 5-8% of all cholecystectomy operations.

HERNIAS

A hernia is an abnormal protrusion of a “structure” or organ through the cavity that normally contains it. Hernias can occur in any part of the body but the most common site is the abdominal wall. The organ or “structure” that usually protrudes through the abdominal wall is either intestines or fatty tissue.

There are numerous types of hernias:

Inguinal :Most common type and is typically located at the groin crease.

Femoral:More common in elderly females. It is also located at the groin and has a higher probability of “strangulating”

Epigastric: Located in the midline, between the navel and the “chest bone”, at the rectus muscle. It usually contains fatty tissue and not intestines.

Umbilical hernia: Located at the navel, most are noted at birth but some occur later in life.

Incisional hernia: Located at the previous site of surgery. The previous surgery creates a weakness in the abdominal wall which a hernia develops. It occurs in about 2-10% of all abdominal surgeries.

Risk factors and symptoms:Hernias can be caused by conditions that increase the abdominal pressure. For example, constipation, obesity, chronic cough, staining during bowel movements and lifting heavy objects.

Hernias generally present as lumps, these lumps may get bigger with time. They are said to be “reducible” if the lump can be “pushed” back into it’s normal cavity.

When the hernias are painful and cannot be “reduced” or “pushed back”, they are referred to as “irreducible”. In this situation, the blood supply to the hernia contents may be “cut-off” and it is said to be “incarcerated”. This condition is a surgical emergency.

Treatment

Conventional repair-The abnormal” protrusion” is pushed back into it’s cavity and the defect in the abdominal wall is closed with sutures. This operation may cause some “tension” in the repair.Mesh repair-Most common technique using a “tension free” mesh. The mesh is sutured or placed to re-enforce the defect in the abdominal wall. It has less pain and recurrences when compared to the conventional method.Laparoscopic repair-Small incisions are made and the mesh is inserted to re-enforce the defect. This method avoids large incisions and is cosmetically better. Laparoscopic repair is more suited for bilateral inguinal hernias or recurrent hernias.

The laser treatment works best when the hair follicle is in the growth phase. Hair removal is safe, effective, has no downtime and is almost painless. Laser hair removal can be performed on any body area including the armpits, legs, back, face and neck.

Mulitple sessions are usually required to achieve optimum results. The treatments are performed 4 to 6 weeks apart and most patients require between 4 to 6 sessions.

After several sessions/treatments, most patients will observe that the hair growth is less and the hair itself is finer.